Our case for change identifies the fragility of primary care as one of the key issues facing the system. Improving this is key to delivering on all our other priority areas, particularly local care and prevention.
The current challenges in general practice include high workloads and workforce shortages:
- Currently individual doctors may see or speak to 40-60 patient per day
- Consultation rates were up by 15% between 2010/11 and 2014/15
- The complexity of care patients need is increasing with greater number of older people needing support with multiple long-term conditions.
- Across Kent and Medway there are 245 fewer GPs and 37 practice nurses fewer than the national average.
- 12% of local GP posts and 30% of practice nurse are vacant, with half of the doctor vacancies unfilled for more than a year.
- 30% of GPs are over 55 so approaching retirement.
From the patient’s perspective this pressure is contributing to:
- wide variation in whether people would recommend their GP practice to a friend – between 68% and 84%
- significant variation in access – both in terms of practices open on Saturday and Sunday, and open after 7pm
The risks of these issues not being addressed include:
- Later identification of disease and missed opportunities for prevention
- More complications and worsening of disease if long-term conditions aren’t managed
- Increased activity in hospitals if people use A&E because they can’t easily access their GP
- Pressure on mental health services if conditions aren’t identified until they reach crisis level
- GPs reporting high levels of stress and burnout, and increased practice closures locally
Work will initially focus on general practice. In future the workstream will also look at the other parts of primary care (dental, community pharmacy, and optometry (eye health). Immediate objectives for the workstream are to:
- Complete a baseline assessment to identifies priority areas. The assessment will look at a range of issues including: variation in quality, workforce and training, premises, productivity and availability of extended hours.
- Establish priority work to address the gaps identified by the baseline assessment.
- Develop a single primary care strategy for Kent and Medway; with local implementation plans that supplement the local care workstream plans.
The workstream is jointly chaired by Dr Fiona Armstrong, Clinical Chair of Swale NHS Clinical Commissioning Group and Dr Mike Parks from the Kent Local Medical Committee.